Positive Behaviour Support



There are estimated to be 800.000 people with mild and 112.000 people with severe intellectual disability in the UK (1, 2). Challenging behaviours are very common in this population with point prevalence in adults of 22.5% and a two year incidence of 4.6%. Aggression is by far the most common type of challenging behaviour with a reported prevalence of 11% to 27% (3). A pilot RCT showed that Applied Behaviour Analysis (a precursor of PBS) can significantly improve irritability, lethargy and hyperactivity and may be cost neutral over six months (4). The total NHS funding for people with intellectual disability is 2.49 billion over and above the costs of generic NHS services (2008 prices) and the upward trend in health expenditure for people with intellectual disability has continued to rise at an estimated rate of 24.3% between 2003 and 2008 (5).

PBS is a multicomponent intervention to support people with intellectual disability and challenging behaviour. PBS more specifically has developed into a discipline that focusses on the environmental influence on behaviour rather than solely on the internal drivers of the behaviours (6,7). PBS practice includes a functional assessment of the possible relationships between specific environmental events and the target behaviours. By identifying what reinforces the behaviour, practitioners can put into place interventions which are designed to foster adaptive actions. The final aim is to enhance the individual's quality of life and his/her integration within the local community.